Renal malignancy

Question 1

What are the associations for renal cancer?

Answer 1

more common in middle-aged men
smoking
von Hippel-Lindau syndrome
tuberous sclerosis

Question 2

What are the features of renal cell cancer?

Answer 2

classical triad: haematuria, loin pain, abdominal mass
pyrexia of unknown origin
left varicocele (due to occlusion of left testicular vein)
endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
25% have metastases at presentation
paraneoplastic hepatic dysfunction syndrome. Also known as Stauffer syndrome. Typically presents as cholestasis/hepatosplenomegaly. It is thought to be secondary to increased levels of IL-6

Question 3

What is a nephroblastoma?

Answer 3

Rare childhood tumour
It accounts for 80% of all genitourinary malignancies in those under the age of 15 years
Up to 90% will have a mass
50% will be hypertensive
Diagnostic work up includes ultrasound and CT scanning

Question 4

What is transitional cell carcinoma?

Answer 4

Accounts for 90% of lower urinary tract tumours, but only 10% of renal tumours
Males affected 3x more than females
Occupational exposure to industrial dyes and rubber chemicals may increase risk
Up to 80% present with painless haematuria
Diagnosis and staging is with CT IVU

Question 5

What is renal cell carcinoma?

Answer 5

Most present with haematuria (50%)
Common renal tumour (85% cases)
Paraneoplastic features include hypertension and polycythaemia
Most commonly has haematogenous mestastasis

Question 6

What are the risk factors for bladder cancer?

Answer 6

Second most common urological cancer
Males between 50-80 
Smokers 
Exposure to hydrocarbons 
Schistosomiasis

Question 7

What are the types of bladder cancer?

Answer 7

Benign- uncommon
Malignancies:
Transitional cell carcinoma (>90% of cases)
Squamous cell carcinoma ( 1-7% -except in regions affected by schistosomiasis)
Adenocarcinoma (2%)

Question 8

What is the presentation of bladder cancer?

Answer 8

Painless, macroscopic haematuria

Flexible cystoscopy to investigate

Question 9

What is renal cell carcinoma?

Answer 9

Adenocarcinoma of the renal cortex, arises from PCT
Spread into adrenal gland, renal vein or surrounding fascia
Males affected more
Haematuria, loin pain, mass
CT scan first line